Hello, and welcome to all the attendees. I thank you for taking the time to hear about this interesting case we have. My name is Faisal Asif, and I am a current PGY4 Co-Chief Resident in the Department of Physical Medicine and Rehabilitation at the University of Toledo College of Medicine. For this case report presentation, we describe the rehabilitation course of a young 33-year-old male admitted to our inpatient unit. The patient had a history of substance use, including the use of vaping products for an undisclosed period of time. On his initial presentation to the outside hospital, he was found to have acute onset shortness of breath, initially concerning for an asthma exacerbation. Of note, this individual had no previous history of asthma, but it's interesting to know that this is not uncommon, as the literature does show approximately 20% or so of patients having history of underlying asthma. Early in his hospital course, this individual developed hypoxic respiratory failure, which required intubation. Overall, his presentation did meet certain criteria for suspected e-cigarette or vaping product use associated lung injury. This criteria included vaping in the last 90 days preceding presentation, lung opacities on chest CT, and an absence of an alternative diagnosis. Our patient, unfortunately, had a prolonged hospital course, including transfer to another tertiary care facility for continued care in the ICU. After eventual successful extubation, he underwent an evaluation by the physiatry team and was deemed an appropriate candidate for acute inpatient rehabilitation, considering his substantial weakness. Our patient's weakness primarily involved his wrist extensors and ankle dorsiflexors. Of course, as physiatrists, our goal early on was to use appropriate bracing to assist his ability to be functionally mobile and help with ADL completion. We soon realized there was concern for the development of pressure injuries due to the difficulty with self-turning. Providing a low air loss mattress helped to mitigate this risk during his stay. As you can see, our patient's initial functional status was primarily at a moderate assist level with activities such as eating, transfers, bed mobility, and was dependent for toileting. His rehabilitation course was unfortunately complicated by pneumonia found after the patient began to spike fevers and complained of pleuritic chest pain. Fortunately, with the close oversight of pulmonology, as our patient was high risk for an acute care transfer, he received the appropriate antibiotics and responded very well. His rehabilitation course was otherwise successful, as he worked with physical and occupational therapy. His success was clear, as he had reached an independent level of function for bed mobility, modified independent for transfers, ambulation, bathing, dressing, and toileting. The patient was subsequently safely discharged home with his wife, and at about two months following his initial presentation, he was seen in the outpatient clinic for follow-up. We conducted an EMG and nerve conduction study at that time, which revealed evidence of peripheral polyneuropathy consistent with critical illness neuropathy, which had been suspected all along. The patient continued participation in a structured outpatient therapy program, and had follow-up approximately four months after his initial presentation. Although he had residual risk weakness, was deemed otherwise functionally back to his baseline and appropriate for return to work. So why do we find our case interesting or significant? Well, in our field, we celebrate the progress our patients make. And in this case, of the substantial progress made by a young male with confirmed critical illness polyneuropathy, stemming from suspected bathing-associated respiratory failure, we wanted to highlight how he comprehensive rehabilitation program proved so beneficial to his recovery. The rise of e-cigarette use in recent years has posed health-related issues that continue to be examined, and the associated lung injury is an ongoing concern. In cases of critical illness polyneuropathy, early intervention involving an acute intensive rehabilitation program may help improve outcomes. In the case of our patient, his participation in an acute rehab program helped to return his functional abilities back to a baseline where he could eventually return to work. In conclusion, rehabilitation of patients with critical illness polyneuropathy remains a limited area of study, and even more so when you're related to the secondary effects of bathing-associated respiratory compromise. Of course, the long-term implications of rehabilitation measures are yet to be seen, but early evidence such as that presented in our case does suggest successful outcomes. I thank you again for taking the time to learn about our interesting case, and welcome any questions should they arise to my email, which is faiz.tausif.utoledo.edu. Take care, and stay safe.

vaping-associated lung injury

shortness of breath

intubation

acute inpatient rehabilitation

polyneuropathy